Individual
DR. LORETTA MICHELLE LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
241 W 138TH ST, NEW YORK, NY 10030-2102
(212) 694-2392
(212) 694-4020
Mailing address
3307 HUNTER AVE, APT 1, BRONX, NY 10475-1543
(718) 676-5262
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
NOO4658
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01148892
—
NY
01
—
480026772
RAILROAD MEDICARE
NY
Enumeration date
02/07/2006
Last updated
12/02/2009
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